Forces Align in Tennessee for Choosing Wisely

October 2, 2014

Competing interests are a common concern for health care institutions working on improving quality. They often track multiple measures, such as PQRS, Medicare or commercial metrics. In Memphis, however, the health care community has used the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) effort and the Choosing Wisely® campaign to form a consensus on which measures are most important to improving the quality of life and health of people in the metro area.

The AF4Q Physician Quality Advisory Committee (convened by the local medical society and the Common Table Health Alliance), all major health systems and Tennessee Medical Association agreed on a group of 10 quality measures for all primary care doctors to track in their practices in Memphis and Shelby County – including four drawn from specialty society Choosing Wisely recommendations. The Tennessee Medical Association (and its agent, the Memphis Medical Society) is a Choosing Wisely grantee, and the Common Table Health Alliance is the local health collaborative leading the Aligning Forces campaign in the region.

For well over a year, the collaborating bodies have worked with hospitals, small practices, medical societies and the physician community to come to consensus on the measures.

The final list includes:

From the Choosing Wisely lists
1. Don’t do imaging for low back pain within the first six weeks, unless red flags are present. (AAFP)
2. Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement. (AAFP)
3. Don’t order annual EKGs or any other cardiac screening for low-risk patients without symptoms. (AAFP)
4. Don’t obtain preoperative chest radiography in the absence of a clinical suspicion for intrathoracic pathology. (ACP)

For patients with diabetes aged 18 to 75
5. Maintain blood pressure control of <140/90
6. Lower LDL cholesterol to less than 100
7. Maintain hemoglobin A1c at less than 8.0%
8. Maintain blood pressure <140/90 (for patients with hypertension)

Competing measurement demands have been cumbersome and chaotic for physicians, according to Stewart Dismuke, project director for the Choosing Wisely grant project. He shares that the goal of this new project is to use measures, such as the Choosing Wisely recommendations, to see if population-wide improvement in health can be achieved, yet not overburden physicians.

“We wanted to create a platform of measurement first and get consensus from the physician community that this is a reasonable approach. The next phase of the plan is to introduce these measures to health plans to get a commitment to link compensation to this data alignment,” says Renee Frazier, CEO of the Common Table Health Alliance.

The group focused on including recommendations that not only improve quality of care, but also would help better steward the resources of the community. According to Frazier, physicians were more comfortable adopting recommendations from the Choosing Wisely campaign than those focused on cost control.

Future plans include tracking the improvement of these measures at a community level. Shelby County has made progress in this area through development of community registries and creation of a data source based on local EHR data.

The community-wide measures are a strong example of multiple health improvement campaigns aligning and working toward a common goal of improved health in a community.